Unpacking Social Determinants of Cancer Disparities: A Systematic Review and Strategic Framework for Equitable Prevention and Control
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Background
Cancer disparities persist in the United States, with significant variations in incidence, mortality, and survival rates across different population groups. This systematic review aims to synthesize current evidence on the relationship between social determinants of health and cancer disparities, and to identify effective interventions for promoting equitable cancer prevention and control.
Methods
We conducted a systematic search of PubMed, Embase, and Cochrane Library databases for peer-reviewed articles published between 2010 and 2024. Studies were included if they examined the association between social determinants (e.g., socioeconomic status, race/ethnicity, education, healthcare access) and cancer outcomes, or evaluated interventions addressing these factors. Two independent reviewers screened articles, extracted data, and assessed study quality using standardized tools.
Results
Of 3,247 initially identified studies, 142 met inclusion criteria. The review found strong evidence linking various social determinants to cancer disparities, particularly in screening rates, stage at diagnosis, and survival outcomes. Socioeconomic status and healthcare access were the most frequently studied determinants. Effective interventions identified included patient navigation programs, community-based education initiatives, and policy changes to expand insurance coverage. However, the quality and long-term impact of many interventions were limited by short follow-up periods and small sample sizes.
Conclusion
This systematic review confirms the significant role of social determinants in perpetuating cancer disparities and highlights promising strategies for addressing these inequities. Future research should focus on developing and evaluating multilevel interventions that target both individual and structural determinants. Policy makers and healthcare providers should prioritize evidence-based approaches to reduce social barriers and promote equitable cancer prevention and control.
